Dietary Supplements for Treating Tinnitus

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Most over-the-counter tinnitus supplements promise relief but lack solid evidence and may even carry risks.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Our journey through the tinnitus universe would not be complete without reviewing the plethora of over-the-counter so-called tinnitus “cures.” Do any of the marketers’ promises ring true?

The wide array of unproven over-the-counter tinnitus remedies indicates just how high the demand is on the part of tinnitus patients. And dietary supplements are lightly regulated and highly lucrative. In a survey of the effectiveness of dietary supplements to treat tinnitus, the most used were ginkgo biloba, lipoflavonoid, vitamin B12, zinc, magnesium, and melatonin––despite U.S. guidelines recommending against herbals, nutraceuticals, and supplements for tinnitus management. Tinnitus supplement users reported adverse effects including all sorts of symptoms: stomach pain, diarrhea, nausea, dizziness, headache, bleeding, chest pain, and palpitations.

A common supplement used for tinnitus is ginkgo biloba. At the time this Cochrane review was written, the two studies of ginkgo biloba that made the cut had little to no effect on THI scores compared to placebo. Since then, I could find one additional placebo-controlled trial with gingko biloba. Treatment groups received 60mg of ginkgo biloba twice a day either by itself or in combination with antioxidants––a mix of beta-carotene, vitamin C, vitamin E, and selenium. After 14 weeks, the THI scores had decreased 18% in the ginkgo biloba group, and 36% in the gingko biloba plus antioxidants group. While those sound impressive as percentages, the ginkgo biloba group only decreased their THI score by 6 points––not a clinically significant amount, about the amount expected from the placebo effect alone. And somewhat oddly, we actually see no placebo effect in the placebo group in the ginkgo biloba study. Okay, but what about the ginkgo biloba plus antioxidants group? They had an impressive 11-point drop. But should we really be taking supplements with additional antioxidants like vitamin E, which has been associated with a small but significant increase in mortality risk and higher prostate cancer risk in men?

While the study authors conveniently claim European and American guidelines recommend ginkgo biloba, if you actually look at the guidelines, they specifically recommend against their use, citing no proven efficacy AND potential harm.

Other supplements have been put to the test, with no clinically meaningful effect over control found for açaí, melatonin, and Korean red ginseng.

In 1979, a woman presented to the clinic with tinnitus in both ears. She had no history of ear infections, trauma, hearing loss, or other risk factors. But she did have pernicious anemia, likely due to very low vitamin B12 levels. Once her B12 deficiency was corrected, her tinnitus completely resolved. Could this be the case for other people with tinnitus? In a double-blind clinical trial, one month of vitamin B12 treatment led to…… no distinctive effect on reducing tinnitus severity. However, in another trial of B12 supplementation, it did improve tinnitus severity among people with B12 deficiency by about eight points. So, for someone who is deficient, restoring B12 to normal levels could help with their tinnitus symptoms.

Published reports of tinnitus randomized controlled trials often include “spin,” reporting practices that distort results and mislead readers by being more optimistic than the results justify. When encountering a newly-published trial, keep in mind that randomization and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Our journey through the tinnitus universe would not be complete without reviewing the plethora of over-the-counter so-called tinnitus “cures.” Do any of the marketers’ promises ring true?

The wide array of unproven over-the-counter tinnitus remedies indicates just how high the demand is on the part of tinnitus patients. And dietary supplements are lightly regulated and highly lucrative. In a survey of the effectiveness of dietary supplements to treat tinnitus, the most used were ginkgo biloba, lipoflavonoid, vitamin B12, zinc, magnesium, and melatonin––despite U.S. guidelines recommending against herbals, nutraceuticals, and supplements for tinnitus management. Tinnitus supplement users reported adverse effects including all sorts of symptoms: stomach pain, diarrhea, nausea, dizziness, headache, bleeding, chest pain, and palpitations.

A common supplement used for tinnitus is ginkgo biloba. At the time this Cochrane review was written, the two studies of ginkgo biloba that made the cut had little to no effect on THI scores compared to placebo. Since then, I could find one additional placebo-controlled trial with gingko biloba. Treatment groups received 60mg of ginkgo biloba twice a day either by itself or in combination with antioxidants––a mix of beta-carotene, vitamin C, vitamin E, and selenium. After 14 weeks, the THI scores had decreased 18% in the ginkgo biloba group, and 36% in the gingko biloba plus antioxidants group. While those sound impressive as percentages, the ginkgo biloba group only decreased their THI score by 6 points––not a clinically significant amount, about the amount expected from the placebo effect alone. And somewhat oddly, we actually see no placebo effect in the placebo group in the ginkgo biloba study. Okay, but what about the ginkgo biloba plus antioxidants group? They had an impressive 11-point drop. But should we really be taking supplements with additional antioxidants like vitamin E, which has been associated with a small but significant increase in mortality risk and higher prostate cancer risk in men?

While the study authors conveniently claim European and American guidelines recommend ginkgo biloba, if you actually look at the guidelines, they specifically recommend against their use, citing no proven efficacy AND potential harm.

Other supplements have been put to the test, with no clinically meaningful effect over control found for açaí, melatonin, and Korean red ginseng.

In 1979, a woman presented to the clinic with tinnitus in both ears. She had no history of ear infections, trauma, hearing loss, or other risk factors. But she did have pernicious anemia, likely due to very low vitamin B12 levels. Once her B12 deficiency was corrected, her tinnitus completely resolved. Could this be the case for other people with tinnitus? In a double-blind clinical trial, one month of vitamin B12 treatment led to…… no distinctive effect on reducing tinnitus severity. However, in another trial of B12 supplementation, it did improve tinnitus severity among people with B12 deficiency by about eight points. So, for someone who is deficient, restoring B12 to normal levels could help with their tinnitus symptoms.

Published reports of tinnitus randomized controlled trials often include “spin,” reporting practices that distort results and mislead readers by being more optimistic than the results justify. When encountering a newly-published trial, keep in mind that randomization and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

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